Senior Officer - RCM

Key Responsibilities 1. HIS Master Data Management • Manage and maintain critical HIS master data required for accurate RCM billing and revenue capture. • Maintain pricing masters , including tariffs, rate plans, effective dates, payer-specific pricing and related configurations. • Maintain package masters , including package components, pricing, validity and payer/plan applicability. • Manage Insurance Plan / Policy Masters , including insurer, plan, network and rate-plan mappings. • Ensure timely and accurate implementation of approved pricing, contractual, payer and regulatory changes within HIS. • Perform detailed validation and QC of master-data updates before and after implementation. • Ensure appropriate documentation, approvals and audit trails are maintained for master-data changes. • Identify and resolve incorrect mappings, duplicate masters, configuration inconsistencies and other data-quality issues. 2. HIS System & Process Improvements • Proactively identify system and process gaps within the RCM billing lifecycle and assess their operational and financial impact. • Review existing workflows, system configurations and business processes to identify opportunities to improve efficiency, controls and billing accuracy . • Work with RCM stakeholders and IT/HIS teams to define and implement system enhancements addressing identified gaps. • Translate operational requirements into business requirements, functional specifications and system/process improvement opportunities . • Evaluate opportunities to introduce system controls, validations, alerts, workflow changes and automated checks to prevent errors at source. • Participate in solution design, testing, UAT and implementation of system and process enhancements. • Monitor implemented changes to ensure the intended business outcome is achieved and identify any downstream impacts. • Maintain a structured log of system/process improvement opportunities, prioritizing initiatives based on business impact, risk, effort and revenue implications . 3. Digital Solutions & Automation • Identify manual, repetitive and error-prone RCM activities that can be improved through automation, digital tools or workflow solutions . • Work with IT and relevant stakeholders to test and operationalize solutions. • Assess the effectiveness of implemented solutions through measurable improvements in accuracy, turnaround time, manual effort and process control . • Continuously identify opportunities to simplify and digitize RCM processes. 4. Master Data Quality & System Controls • Establish and perform appropriate maker-checker and QC controls for critical HIS master-data updates. • Conduct periodic audits of pricing, package and insurance master data. • Validate effective dates, pricing logic, payer mappings and other critical parameters against approved source documents. • Analyse billing issues linked to incorrect system configuration and perform root-cause analysis. • Recommend system or process controls to prevent recurring errors. • Ensure master-data standards and system configurations are consistently applied across facilities and business units. 5. RCM Analytics & Operational Insights • Analyse RCM operational data to identify billing trends, anomalies, process gaps and potential revenue leakage . • Develop and maintain operational reports and dashboards supporting RCM performance monitoring. • Analyse the impact of pricing, system and process changes on billing outcomes. • Provide data-driven insights to support prioritization of system enhancements and process improvements. • Support RCM management with analysis of operational issues and improvement opportunities. • Bachelor's degree in Healthcare Administration, Business, Finance, or a related field. • Minimum of 5-7 years of progressive experience in Revenue Cycle Management within the healthcare industry. • Certified Professional Biller (CPB) or Certified Revenue Cycle Executive (CRCE) certification is highly preferred. • Proven track record of successfully managing RCM operations and achieving financial targets.